6211 swot pocus

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There are a variety of tools available to assess potential investments. One of the more common tools is the Strengths, Weaknesses, Opportunities, and Threats assessment (SWOT). Stonehouse (2018) describes a SWOT assessment as looking at both positives and negatives; from the inside and outside. After these four categories are thoroughly identified; an analysis can be done. The analysis is what will guide decision making and ensure the best options. The SWOT analysis can be done to assess the proposal of implementing Point of Care Ultrasound (POCUS) in the organization. Strengths There are many strengths associated with implementing a POCUS program at the organization. Suttles et al. (2022) reports it is easy to use and accessible; allowing for quick diagnosis with little to no risk to the patient. This device has been shown to be in good comparison with high end US systems over all (Rykkje, 2019). Our EHR has already been equipped with the necessary builds for order sets, flow sheets, and other essential documentation (Rong et al., 2021). The cost for two Clarius ultrasound devices, necessary accessories, shipping, and subscription fees is very reasonable; at $6178. This includes education, continuous tech support, and HIPPA compliance storage for the scans (Clarius 2022). Weakness There are weaknesses associated with implementing the POCUS service. The biggest is in regards to training. Not all physicians have received POCUS training during their residency (Kennedy et al., 2022). Another weakness is related to the EHR system. The organizations licensing is managed under a larger organization. This requires going through that organization to activate the necessary documentation. However, the builds are already complete, they just need to be made available to the organization. Opportunities

POCUS offers many opportunities for both the community and the organization by increasing ultrasound service availability at a fraction of the cost. The World Health Organization recommends task shifting, such as the use of POCUS by frontline providers in lieu of radiology department, as a technique to close the gap by making best use of the workforce and providing quicker care (Abrokwa, 2022). POCUS allows for immediate diagnosis and treatment decisions. Goldsmith et al. (2020) reports that diagnostic errors contribute to 40,000 – 80,000 deaths annually, and POCUS has been shown to lower procedure-related complications. Threats There are a number of factors that could pose a threat to the POCUS program. The biggest threat would be from not using ultrasound to its fullest potential. This could occur either from inefficient documentation; resulting in claim denials, or from performing a minimal number of scans; meaning fewer claims to submit for reimbursement. Less than 30% of organizations use all the available POCUS modalities; reporting that the biggest barriers are (1) insufficient trained providers, (2) limited access to equipment, and (3) insecure with interpreting images without a radiologist review (Jeffrey, 2020). Another threat would be related to the EHR and unexpected network, system, software issues. Cost and Revenues within SWOT Analysis POCUS offers a great opportunity to produce revenue for the organization. The potential revenue streams represent a strength which outweigh potential costs; limiting any budget concerns. Scans with appropriate documentation and images are reimbursed on average $50- 125 (CMS, 2022). If the organization maintains the average number of ultrasound procedures annually it would generate $70,000 from reimbursement alone. In addition, annual savings greater than $600,000 can be generated from decreasing the length of stay (LOS) by 0.7 days (Marshall Medical Center, 2022). Furthermore, POCUS has been shown to eliminate the need for many additional tests; saving on average $1381/patient and over $1,000,000 annually (Van Schaik et al., 2019). References

Abrokwa, S. K., Ruby, L. C., Heuvelings, C. C., & Bélard, S. (2022). Task shifting for point of care ultrasound in primary healthcare in low-and middle-income countries-a systematic review. EClinicalMedicine , 45 , 101333. Clarius: Portable pocket handheld ultrasound scanners. Clarius. (2022). https://clarius.com/ CMS. (2022). Physician fee schedule. CMS.gov.https://www.cms.gov/Medicare/Medicare-Fee- for-Service-Payment/PhysicianFeeSched. Insurance & Billing. Marshall Medical Center. (2022). https://www.marshallmedical.org/patients-visitors/patient- information/insurance-billing-information/ Goldsmith, A. J., Shokoohi, H., Loesche, M., Patel, R. C., Kimberly, H., & Liteplo, A. (2020). Point-of-care Ultrasound in Morbidity and Mortality Cases in Emergency Medicine: Who Benefits the Most?. The western journal of emergency medicine , 21 (6), 172–178. https://doi.org/10.5811/westjem.2020.7.47486 Jeffrey, W. W., et al. (2022). Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study. Fam Med .;52(7).DOI: 10.22454/FamMed.2020.223648 Kennedy, SK , Ferre, RM , Rood, LK , et al. (2022). Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty . AEM Educ Train . ; 6 :e10744. doi: 10.1002/aet2.10744 Eldorado County Public Health Department. (2021). Marshall-Medical-Center-2019-CHNA- Final-Report-7.3.19. WellDorado :: Resource Library :: Collection :: Community Health Assessments. http://www.welldorado.org/resourcelibrary/index/collection? id=106303637538045196 Rong, K., Chimileski, B., Kaloudis, P., & Herbst, M. K. (2021, June 7). Impact of an epic- integrated point-of-care ultrasound workflow on ultrasound performance, compliance, and potential revenue. The American Journal of Emergency Medicine. Retrieved June 23, 2022, from https://www.sciencedirect.com/science/article/pii/S0735675721004927

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Rykkje, A., Carlsen, J. F., & Nielsen, M. B. (2019). Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel, Switzerland) , 9 (2), 61. https://doi.org/10.3390/diagnostics9020061 Stonehouse, D. (2018). SWOT: What is it all about and how do you use it? British Journal of Healthcare Assistants, 12(12), 617–619. doi:10.12968/bjha.2018.12.12.617 Suttels, V., Toit, J. D., Fiogbé, A. A., et al. (2022). Point-of-Care Ultrasound for Tuberculosis Management in Sub-Saharan Africa-A Balanced SWOT Analysis. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases , S1201-9712(22)00398-8. Advance online publication. https://doi.org/10.1016/j.ijid.2022.07.009 Van Schaik, G.W.W., Van Schaik, K.D. and Murphy, M.C. (2019), Point-of-Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS. J Ultrasound Med, 38: 2133-2140. https://doi.org/10.1002/jum.14910 Shen-Wagner, J., & Deutchman, M. (2020, October 31). Point-of-care ultrasound: A practical guide for primary care. Family Practice Management. https://www.aafp.org/pubs/fpm/issues/2020/1100/p33.html#fpm20201100p33-ut5 Toth, J. (2021, October 3). Utility of point-of-care ultrasound across clinical applications spurs continued growth. Imaging Technology News. https://www.itnonline.com/article/utility- point-care-ultrasound-across-clinical-applications-spurs-continued-growth-0 Garcia, M. (n.d.). What does an unfavorable variance indicate? Retrieved April 23, 2019 from http://smallbusiness.chron.com/unfavorable-variance-indicate-81570.html

Investopedia. (2019, March 31). What is a budget? Budgeting terms and tips. https://www.investopedia.com/terms/b/budget.asp Penner, S. J. (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company. Woodruff, J. (2019). What is budget variance analysis? http://smallbusiness.chron.com/budget- variance-analysis-60250.html The implementation of POCUS and POCUS training for residents: the Rijnstate approach April 2020The Netherlands Journal of Medicine 78(3):116-124 Michiel J BlansMichiel J BlansM E J PijlJ M van de WaterShow all 5 authorsFrank H BoschFrank H Bosch Unfortunately, how to implement POCUS and practical examples how to train staff and junior doctors is not well described in literature. We dis TALON, A., WANG, M., FIRTH, C., & SAEED, A. (2021). STRENGTHS AND WEAKNESSES OF A HYBRID POINT-OF-CARE ULTRASOUND CURRICULUM FOR INTERNAL MEDICINE RESIDENTS DURING COVID-19 PANDEMIC. Chest , 160 (4), A1421. https://doi.org/10.1016/j.chest.2021.07.1300 There is no standardized approach in teaching and multiple barriers have impeded POCUS training. The coronavirus (COVID-19) pandemic has Most trainees (52.3%) reported that access to equipment was the biggest barrier to incorporating POCUS into their practice. The curriculum also increased the likelihood of residents to incorporate POCUS into their future practice. Our pilot study Stonehouse, D. (2018). SWOT: What is it all about and how do you use it? British Journal of Healthcare Assistants, 12(12), 617–619. doi:10.12968/bjha.2018.12.12.617

. 4. The most important stage is the analysis of the four categories, without which the tool is useless. 5. Once your analysis of the SWOT has taken place, you can then make better decisions and changes to benefit both staff and patient care. The SWOT analysis tool can be used for a whole range of applications. For managers “to scan their external environment to identify opportunities and threats so that their internal strengths and weaknesses are aligned accordingly” (Sola et al, 2018:136), to assisting support workers in writing their Professional Development Plans by identifying “areas in which development is required or desired” (Jackson & Thurgate, 2011:293) and by a learner within the workplace to identify opportunities within their environment (Wareing, 2016). first of all you need to assess the current situation rovide a balanced overview of the situation we are analysing,” and not just to focus on the negatives. strength What do you do well and excel at? Are your skills, knowledge and experience you have a strength? The training you have received to support you in fulfilling your role and in meeting the organisations objectives. These strengths could be identified from goo Weaknesses . Are there areas of your organisation, team or even on the individual level which you can recognise as being weak? Are there things missing? This could even be around reputation or image, or deficiencies in accommodation or outdated technology (Mullins, 2013). It could also be on a more practical level of staff shortages, positions not filled, work load, morale of the team, or actual working conditions. Opportunities This is the second positive area but now is outward facing. What opportunities are there outside of your team or organisation? Is there a need being generated by patient expectations, or new guidelines which you could adopt? new that you could start doing? Could new funding be accessed that has previously been unavailable (Phillips, 2009)? This is your chance to identify a new direction, or new service you could be delivering to meet a previously unmet need. Maybe a new technique has been identified to provide care in an improved way? Opportunities could also be experiences gained outside of the current team, which as yet have been unused (Jackson & Thurgate, 2011). Have team member’s talents been unrecognised and unused until now? Threats The last area is negative and outward facing. This is more serious. It is about identifying things which could actually threaten your practice, service or organisation. Are there things out there, external, which could impact negatively on how you provide your service or care? Threats to the organisation or team could be a loss or decrease in budget, or a change in political or societal drivers which may threaten commissioning of the service in the future (Phillips, 2009). Is another organisation providing care in a more productive way Analysis This is the most important part of the process. For the analysis to be worthwhile, time needs to be given to complete the four sections above as fully as possible. As Pettinger (2012:24) states nothing should be off limits, only “once everything is in front of people, evaluations and judgements can then be made.” Once recorded you need to be able to tell what the strengths, weaknesses, opportunities and threats are telling you. If done too quickly or as a tick box exercise, there is a risk that SWOT may have been performed, but without the analysis (Thompson, 2012), making the exercise worthless. Thompson (2012) goes on to say that once words have been inputted into the four areas, you are then able to see if there are any patterns or themes emerging. Issues previously unrecognised can be acknowledged and discussed, making the decision making process easier and highlighting the drivers for change.

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to conclude, this article has highlighted the usefulness of the SWOT analysis tool, in supporting an individual, team or department to identify opportunities for change. Support workers and nursing associates will often know more about how a team and department is performing, being the key staff members delivering the most hands on care. They are therefore well placed to contribute the most to a SWOT analysis of the clinical area, suggesting how strengths can be maximised, weaknesses improved upon, opportunities grasped and threats neutralised. All this will help to deliver quality care and services to the patients and families that we serve and support. Myers, Lauren, "Development of a Point-of-Care Ultrasonography Workflow Within a Rural Clinic" (2022). Culminating Experience Projects. 111. https://scholarworks.gvsu.edu/gradprojects/111 References Marie, You suggest an excellent proposal. It sounds very promising. I agree, the benefits of implementing telehealth between EMS and hospital outweigh the setbacks you mentioned. Kim, et al. (2020) reports that the support it offers prehospital; such as prehospital diagnosis, medical procedure guidance, shortened arrival times, and preparation by receiving facility is invaluable. The resources are put to better use, resulting in significant savings from shorter LOS and quicker diagnosis and treatment plans. The weaknesses and threats you described appear to be minimal. They can be easily minimized with strategic planning. Using a flexible budget allows the dollar amounts to changed based on various factors. This could be applied to the concern of your varying census ( Investopedia, 2019). It sounds like your revenue should be able to offset any unexpected variances. References Investopedia. (2019, March 31). What is a budget? Budgeting terms and tips. https://www.investopedia.com/terms/b/budget.asp

Kim Y, Groombridge C, Romero L, Clare S, Fitzgerald M. (2020). Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review. J Med Internet Res 22(12):e18959. https://www.jmir.org/2020/12/e18959. DOI: 10.2196/18959 Shateria, The issue you raise is a valid concern. The gap of service you experience is one I think many organizations face. I understand the frustration of making due with what little there is available. Unfortunately, I think the nursing shortage is going to be the new normal staffing. Organizations are struggling with developing new models of care that is able to provide quality care with limited resources (Lee and Porter, 2019). It is disappointingly that you are not able to obtain the needed supplies to provide the care to the patients up front. One suggestion I can give you, which has been somewhat successful at our organization, is for the discharging department supply the patient with one weeks worth of supplies. There may be pushback from the director of the department due to their own budget concerns. However, there could be options available for the expenses to be covered under other budgets. You may be able to get ‘buy-in’ from senior admin if you can show the savings to the organization from reducing ER visits and readmission rates. The cost of a weeks worth of supplies more than likely outweighs the expense of ‘failed home wound care program.' You mentioned using a cost-effective analysis (CEA). This could help gain support for your proposal. CEA can provide valuable information by providing a net cost savings when comparing the cost of your proposal to the costs averted from decreasing ER use and readmissions (DHSS, 2021 ). References

Lee, T., & Porter, M. (2015, September 14). The strategy that Will Fix Health Care . Harvard Business Review. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care Us Department of health and human services. (2021, October 20). Cost-effectiveness analysis . Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/economics/cost- effectiveness/index.html

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